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Copyright EMAP Publishing 2017

This article is not for distribution

20

Nursing Times [online]

December 2017

/ Vol 113 Issue 12 www.nursingtimes.net

Keywords Fluid resuscitation/'5Rs'/

Crystalloids/Colloids

This article has been

double-blind peer reviewed T o maintain its finely tuned homoeostasis, the human adult body needs an average daily fluid intake of 2.5-3 litres (Moore and

Cunningham, 2017). It also requires a con

stant balance in the levels of nutrients, oxygen and water to preserve a stable internal environment (Moini, 2016). This balance can be easily altered by illness or injury, resulting in a loss of one or all of these elements. This can lead to dehydra tion, hypoperfusion leading to reduced oxygen uptake, and organ dysfunction, so redressing the imbalance is essential.

A reduction in oral fluid intake, the

redistribution of fluid in the vascular spaces and a decreased circulating volume need to be managed. Intravenous fluid therapy is one way of managing reduced fluid intake by reducing its effects and replacing lost fluids.

Recognising the signs and symptoms of

fluid loss is necessary to identify the need for fluid administration. Knowledge of when to administer IV fluids, what type of fluid to administer, and why they are all Key points

The loss of

circulating fluid volume can lead to imbalances in homoeostasis

Recognising,

assessing and monitoring patients' need for fluid therapy is crucial

The '5Rs' of

intravenous fluid administration are: resuscitation, routine maintenance, replacement, redistribution and reassessment

Crystalloids and

colloids, both plasma volume expanders, are used to increase depleted circulating volumes

To administer

intravenous fluids, health professionals must understand what crystalloids and colloids do and when to use them essential. The National Institute for Health and Care Excellence's (2017) guidance on IV fluid therapy in adults in hospital stresses the need for health professionals to under stand the physiology of fluid and electro- lyte balance. It also outlines five 'Rs' of fluid administration (Box 1). However, there are many fluid replacement products available and it is not always clear which one should be used.

This article provides an overview of the

NICE guidance, highlighting what it

means for health professionals adminis- tering IV fluids. It also sheds light on the differences between crystalloid and colloid solutions, and gives practical guidance on when each one should be used.

Physiology

For effective tissue and organ perfusion,

maintenance of finely balanced levels of oxygen, fluid and electrolytes (homoeo stasis) is essential. Fluid volumes need to be distributed into the intracellular and extracellular spaces (the latter being fur ther divided into the interstitial and Choosing between colloids and crystalloids for IV infusion

Author

Lisa Smith is senior lecturer in emergency and urgent care at the University of Cumbria.

Abstract

Hypovolaemia resulting from illness or trauma can precipitate imbalances in homoeostasis due to the loss of circulating fluid volume. By addressing hypovolaemia, homoeostasis can be restored, preventing hypoperfusion and subsequent organ dysfunction. Administering intravenous fluids can replace any lost circulating volume. The National Institute for Health and Care Excellence outlines five 'Rs' of fluid therapy: resuscitation, routine maintenance, replacement, redistribution and reassessment. This article provides an overview of fluid therapy, covering the NICE guidance and clarifying the di?erences between crystalloids and colloids, and when to use them.

Citation

Smith L (2017) Choosing between colloids and crystalloids for IV infusion.

Nursing Times

[online]; 113: 12, 20-23.In this article...

Guidance on intravenous fluid therapy

Parameters that may indicate the need for fluid resuscitation Compared risks and benefits of colloids and crystalloids

Nursing Practice

Review

Intravenous therapy

Copyright EMAP Publishing 2017

This article is not for distribution

21

Nursing Times [online]

December 2017

/ Vol 113 Issue 12 www.nursingtimes.net affect patients' cardiac performance causing arrhythmias, heart failure and/or cardiac arrest. If continued fluid loss is suspected, this should be checked and losses monitored.

Redistribution

Redistribution of fluid can occur in critical

illness. Fluid is lost from the circulatory volume and moves into the tissues; this is called 'third space loss' (Frost, 2015). This may be seen in patients with cardiac failure, renal failure or sepsis, and oedema may be present. To manage these patients effectively, increased monitoring, further assessment and investigations are needed.

In some cases, specialist intervention,

such as the monitoring of central venous pressure, kidney function tests or high dependency care, may be required.

Reassessment

Regular reassessment of patients' fluid

therapy needs is essential. In those who require ongoing fluid therapy for three or more days, the enteral routes of adminis tration should be considered (NICE, 2017).

Enteral routes reduce the need for IV access

and, in doing so, reduce the risks of ongoing IV therapy, such as catheter- related infections.

Types of fluids

Crystalloids

Crystalloid solutions are isotonic plasma

volume expanders that contain electro lytes. They can increase the circulatory volume without altering the chemical bal ance in the vascular spaces. This is due to their isotonic properties, meaning their components are close to those of blood circulating in the body.

Crystalloid solutions are mainly used to

increase the intravascular volume when it is reduced. This reduction could be caused by haemorrhage, dehydration or loss of fluid during surgery. cause of any potential fluid loss. Finding and treating that cause, along with the administration of fluid therapy, is essential to rule out refractory fluid loss. If not addressed, this persistent loss of circulating volume could lead to:

The need for further fluid resuscitation;

Increased volumes of fluid

requirements;

In severe cases, debilitating illness

or death.

NICE (2017) recommends a bolus of

500ml of crystalloid solution (containing

sodium in the range of 130-154mmol/L) over less than 15 minutes in patients requiring fluid resuscitation; this should be avoided for those who have any evi dence of pulmonary oedema as a result of cardiac failure (Frost, 2015). This initial fluid resuscitation should be followed by a reassessment. If further fluid resuscitation is required, then fluid boluses of 250-

500ml should be given. Patients needing

continuous boluses of up to 2L will need further medical review.

Routine maintenance

Routine maintenance fluids are needed in

patients who are at ongoing risk of fluid loss. Reasons for this could be poor fluid intake, recent surgery, bowel dysfunction and other comorbidities. Clinical exami nation, investigations, vital signs monitoring (including fluid balance and weight measurements) can all help to determine a patient's need for routine maintenance fluids.

Replacement

Ongoing assessment of patients' fluid bal

ance is paramount. Assessment should focus on:

Ensuring adequate hydration;

Ensuring electrolyte balance;

Checking for any potential fluid overload. When ensuring normal electrolyte parameters are met, it is particularly important to consider the potassium levels. Alterations in potassium - either hypokalaemia or hyperkalaemia - can intravascular compartments). The move ment of fluid between these spaces is con- tinual. This enables cells to receive their necessary supply of electrolytes such asquotesdbs_dbs12.pdfusesText_18

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